What should be the next step for a positive TB skin test with a negative chest X-ray?

In the scenario where there is a positive TB skin test and a negative chest X-ray, the appropriate next step is to treat the latent TB infection with a regimen of 9 months of isoniazid. A positive TB skin test typically indicates exposure to the tuberculosis bacterium, but the negative chest X-ray suggests that there is no active TB disease present in the lungs at this time.

Latent TB infection means that the bacteria are present in the body but are not actively causing disease, and the individual is not contagious. However, there is a risk that these individuals could develop active TB disease in the future. Therefore, it’s important to initiate treatment to prevent this progression. The standard treatment for latent TB infection is a 9-month course of isoniazid, which is effective in reducing the risk of developing active TB disease.

Immediate hospitalization or initiating treatment for active TB would not be appropriate since the absence of symptoms and the negative chest X-ray indicate that there is currently no active TB disease. Repeating the chest X-ray in 6 months does not address the need for treatment of latent infection and would only delay necessary intervention. Thus, starting treatment for latent TB with 9 months of isoniazid is the best course of